Department of Obstetrics and Gynecology, Anschutz Medical Campus, University of Colorado, 12631 E 17th Ave Ste B198-6, Aurora, CO, 80045-2529, USA.
Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA.
J Assist Reprod Genet. 2021 Feb;38(2):513-516. doi: 10.1007/s10815-020-02057-1. Epub 2021 Jan 6.
To describe a case of a young woman who presented for fertility preservation and underwent ovarian stimulation with an etonogestrel implant in place.
A 24-year old, gravida 0, with an etonogestrel implant and newly diagnosed lower extremity sarcoma and DVT desiring oocyte cryopreservation prior to adjuvant chemotherapy and radiation. To avoid delay in her oncologic care and allow for continued use of contraception post-retrieval, the patient underwent controlled ovarian hyperstimulation (COH) without removal of the etonogestrel implant.
Baseline labs included follicle-stimulating hormone 9 mIU/mL, luteinizing hormone 4.9 mIU/mL, estradiol 42 pg/mL, anti-Müllerian hormone 5.1 ng/mL, and antral follicle count greater than 40. The patient was placed on an antagonist protocol and stimulated with 125 IU Gonal-F and 75 IU Menopur. She received a total of 12 days of gonadotropin stimulation. On the day of trigger, her estradiol was 1472 pg/mL, lead follicle 21.5 mm with a total of 25 follicles measured > 12 mm. She was triggered with 5000 U hCG. She had a total of 23 oocytes retrieved, 17 of which were metaphase II and vitrified.
COH and successful oocyte cryopreservation can be achieved in patients with an etonogestrel implant in situ without apparent detrimental effects to oocyte yield or maturity. Due to the etonogestrel implant's inhibitory effects on LH, it is recommended to use an hCG trigger for final oocyte maturation.
描述一位年轻女性的病例，她因患有下肢肉瘤和深静脉血栓形成，希望在接受辅助化疗和放疗前进行卵子冷冻保存，故前来就诊。该患者已放置左炔诺孕酮宫内节育系统（LNG-IUS），且诊断为 24 岁、初产妇 0 级，我们为其实施了卵巢刺激，使用了左炔诺孕酮宫内节育系统。
为避免延迟肿瘤治疗，并允许在取回后继续使用避孕方法，我们在不取出左炔诺孕酮宫内节育系统的情况下对患者进行控制性卵巢过度刺激（COH）。
基础实验室检查包括卵泡刺激素 9 mIU/mL、黄体生成素 4.9 mIU/mL、雌二醇 42 pg/mL、抗苗勒管激素 5.1 ng/mL 和窦卵泡计数大于 40。患者接受了拮抗剂方案治疗，并接受了 125 IU 果纳芬和 75 IU 美诺孕素的刺激。她接受了总共 12 天的促性腺激素刺激。在触发日，她的雌二醇为 1472 pg/mL，主导卵泡为 21.5 mm，共有 25 个卵泡测量值大于 12 mm。她接受了 5000 U hCG 触发。共取回 23 个卵子，其中 17 个处于中期 II 期并进行了玻璃化冷冻。
在左炔诺孕酮宫内节育系统原位的患者中，可以进行 COH 和成功的卵子冷冻保存，而对卵子产量或成熟度似乎没有明显的不利影响。由于左炔诺孕酮宫内节育系统对 LH 的抑制作用，建议使用 hCG 触发剂进行最终卵子成熟。
